The international sound and fury over the Pakistani floods has died down – and yet, flood victims still face a serious crisis. Most notably, the health crisis associated with the flooding has only recently begun to unfold, and yet the international aid and attention just is not there the way it was in the very beginning of the crisis. How should Pakistan face this host of problems with such limited funding?

As early as the beginning of August, the Punjab government in Pakistan and UNICEF both underlined the imminent threat of epidemics of waterborne diseases in areas affected by flooding. These diseases include a vast number of digestive problems, as well as flu, hepatitis, cholera, typhoid, malaria, and a host of other diseases continually battled by international aid programs. While some of these diseases were addressed by deploying extra vaccinations to affected areas, others were largely forgotten in the race to provide basic needs like food and shelter for refugees.

Developed countries pledged large quantities of aid, and even increased their pledges after an August appeal from the United Nations, which set the target for pledged aid at $2 billion. It is unclear whether this target has been met, how much of this aid has actually been disbursed, or what percentage of it is being used for health purposes, given how recent the disaster is. However, what is clear is that flood-related damage in Pakistan is estimated to be up to $43 billion. In September, U.N. agencies said that 21 million people have been affected, and 12 million need emergency food aid. Even if the U.N. aid target is reached, that aid money will be spread very thinly across the vast number of people affected and the various problems generated by flooding.

Although there are no official figures on how much aid is being spent on health issues, an early report from the World Health Organization sheds some light on the issue. Of the initial $459 million that the U.N. asked for immediately following the floods, only $59 million was targeted at health. The WHO was forced to redirect health aid from other areas in Pakistan to flood-stricken areas simply to meet the initial demand for medicines, meaning that other health problems outside of those associated with the flooding were being affected by the lack of overall funding. Reports in August stated that the WHO’s stock of medicine was only adequate for 220,000 people, and that around $6.5 million was needed to repair 72 health facilities so that a larger number of people could be treated.

Sadly, in this health crisis, those most dramatically affected are children under the age of five. Weak immune systems, systemic malnutrition and unsanitary shelters situated in the midst of stagnant water all contribute to make children under five easy targets for a variety of illnesses. Newspapers in Pakistan issued warnings from doctors and pediatricians as well as a list of precautionary measures to help refugees cope and protect their children, but the same papers reported that government agencies and NGOs were “not taking much care” to spread warnings about waterborne illness.

At the end of August, the WHO issued a report assessing health risks for the next six months in Pakistan, warning that as many as 3.7 million children under five in flood-stricken areas could contract diarrhea. The same report warned that Pakistan would soon see many cases of malnutrition, malaria and pneumonia. In September, a UNICEF representative described the aid effort as “stuttering,” especially in addressing health issues for children under five. Clearly, the conditions described in the WHO reports continue to be issues that are not adequately addressed.

What can Pakistan do? There are so many problems emerging in conjunction with the flooding in Pakistan, and it seems that developed nations are becoming fatigued with giving aid to address them. Richard Holbrooke, U.S. special representative for Afghanistan and Pakistan, said on Sept. 16 that it was Pakistan’s duty to raise the billions of dollars necessary to reconstruct the parts of the country hit and that the international community would not be able to raise those funds for them. Pakistan is having trouble meeting the conditions for continued IMF funding, and has not raised taxes on its population either – sources of funding are few and far between.

There are a few “tricks” to maximize the impact of the small amount of aid already being given, in my opinion. In light of the amount of information available on the specific health issues that are arising in flood-affected areas, developed nations should be able to target their aid on very precise goals so that what little aid is earmarked for health can have the greatest impact. Highly detailed goals will also help developed nations keep track of where the aid is going and its results, resulting in greater government accountability. Aid should also be given through diverse channels, especially through non-governmental organizations and other civil society groups, to minimize the risk of losing aid through corruption.

NGOs giving aid to Pakistan should be encouraged to work at the community level with doctors in the area to create programs to spread awareness of preventive measures, give as many vaccinations as possible with current level of supplies, and create more sanitary conditions, especially linked to septic drainage in refugee camps. Community-based solutions implemented through a mobilization of refugee groups will be the key to effective use of limited funds, and will also ensure that the solutions used address the actual problems at each site.